不同胱抑素方程对我国慢性肾脏病患者的适用性评估

目的评价在血清胱抑素C(Cys-C)含量基础上开发的肾小球滤过率(GFR)评估方程在我国慢性肾脏病(CKD)患者的适用性。方法选择2008年1月至2009年11月我院肾内科就诊的412例CKD患者,将简化MDRD方程、Cys-C方程1～5计算的GFR值与99mTc-DCPA测定的GFR(sGFR)进行比较。结果各方程计算的GFR与sGFR总体上均呈显著性相关(P<0.001),Cys-C方程4和Cys-C方程5估算的GFR与sGFR的一致性最佳,Cys-C方程4、5的准确性和精确度均高于其他方程。在CKD1～5期,Cys-C方程4、5的准确性高于其它方程(P<0.001)。所有方程中仅Cys-C方程5的偏差一致性限度在事先规定的专业界值60ml·min-1·1.73m-2之内。结论Cys-C方程4、5的准确性、精确度均优于以往的GFR评估方程,并在不同CKD分期病人中有较好的适用性。但该方程的一致性限度仍存在不足,有必要进行进一步的检验和方程,为临床提供更加准确和适用的肾功能评估方法。     

三种CKD-EPI公式对膜性肾病患者肾小球滤过率评估的一致性评价

分析不同公式估算的膜性肾病患者肾小球滤过率(GFR)与肾动态GFR的一致性。通过检测膜性肾病患者血清肌酐(Scr)及胱抑素C(Cys-C)水平,评估三种公式估算的GFR与肾动态GFR一致性。三种公式对于不同性别估算的GFR值之间差异有统计学意义,CKD-EPI2012Scr-Cys-C估算的GFR值显著高于CKD-EPI2009Scr和CKD-EPI2012Cys-C;三种CKD-EPI公式估算的GFR与肾动态GFR均具有相关性(P均＜0.05),CKD-EPI2012Scr-Cys-C公式估算的GFR与肾动态GFR相关性较强,CKD-EPI2012Cys-C公式次之,CKD-EPI2009Scr公式最弱。CKD-EPI2012Scr-Cys-C公式计算的GFR与肾动态GFR一致性优于CKD-EPI2009Scr公式和CKD-EPI2012Cys-C公式。CKD-EPI2012Scr-Cys-C公式用于膜性肾病肾功能估算,与肾动态GFR具有更好的相关性和一致性。     

云南少数民族和汉族慢性肾脏病肾小球滤过率评估方程的临床研究

目的 评价肾小球滤过率(GFR)评估方程在云南少数民族和汉族慢性肾脏病(CKD)患者中的适用性.方法 选择174例少数民族和汉族CKD患者,将Cockcroft-Gault方程、MDRD7 方程和简化MDRD方程估算的GFR值用体表面积(BSA)标准化,与BSA标准化的~(99m)Tc-DTPA测得的GFR在不同CKD分期进行比较.结果 方程估算的GFR与~(99m)Tc-GFR(sGFR)呈正相关(P＜0.05),相关性最好的是 MDRD7方程;受试者工作特征(ROC) 曲线下的面积也表明MDRD7方程诊断效率最好,但是MDRD7方程用于我国人群时出现高估或低估偏差.结论 经统计数理方法与临床分期相结合、比较,最终建立了用7GFR值推算sGFR值的校正式:sGFR=7GFR×1.25-11.72.     

不同肾小球滤过率估计公式对体检人群肾功能的评价

目的：探讨不同的肾小球滤过率（GFR）估计公式对体检人群肾功能评价的表现。方法收集8476例职业体检者的血清肌酐、尿素氮、血清胱抑素、尿常规,分别使用慢性肾脏病流行病学合作研究（CKD-EPI）公式、基于血清胱抑素 C 的 CKD-EPI（Cys-EPI）公式、联合血清肌酐和胱抑素 C 的中国 GFR 课题组经验性（CC-EPI）公式、简化 MDRD（a-MDRD）公式、中国改良的 MDRD（c-MDRD）公式计算估计的 GFR（eGFR）。结果体检人群中使用不同 GFR 公式计算出的结果之间有显著相关性（P ＜0．01）。但不同公式计算出的 eGFR 均值差异有统计学意义（P ＜0．01）,与 CKD-EPI 比较,c-MDRD 对 GFR 估计值偏高（P ＝8．7×10－263）。不同公式计算出的 eGFR＜60 mL·min－1·1．73（m2）－1的个体比例差异有统计学意义（P ＜0．01）,且比例差异主要集中在45～59 mL·min－1·1．73（m2）－1范围内。以 CKD-EPI 公式计算的 eGFR 和蛋白尿将其分为 CKD 和非 CKD 两组。在 CKD 人群中,Cys-EPI、CC-EPI、c-MDRD 计算出的 eGFR 偏高;非 CKD 人群中,Cys-EPI、a-MDRD 公式计算的 eGFR 较低,c-MDRD 公式计算出的 eGFR 明显偏高,而 CC-EPI 公式结果与 CKD-EPI 公式最接近。结论不同 GFR 估算公式对体检人群计算出的 eGFR 值有显著相关性,但是各公式在 CKD 和非 CKD 两组间的表现又有明显差异。     

CKD-EPI与MDRD肾小球滤过率评估公式在慢性肾脏病患者中的适用性研究

目的比较慢性肾脏病流行病学合作研究(CKD-EPI)公式、简化MDRD公式和中国改良的简化MDRD公式预测中国慢性肾脏病(CKD)患者肾小球滤过率(glomerular filtration rate,GFR)的适用性。方法选择我院2010年1—4月住院的非外籍CKD患者87例,监测其血清肌酐(Scr)水平,同时行99mTc-DTPA肾动态显像检查,测得的GFR(rGFR)作为参考标准,用CKD-EPI公式、简化MDRD公式和中国改良的简化MDRD公式计算估测的GFR。分析估测的GFR与参考值(rGFR)的相关性,并就3种公式估测的GFR的估测偏差、精确度、准确率及诊断敏感性进行比较。结果 3种肾小球滤过率评估公式估测的GFR与rGFR间的估测偏差、估测偏差绝对值及估测偏差百分位数比较差异均无统计学意义(P>0.05);15%、30%及50%准确率间比较差异亦无统计学意义(P>0.05)。CKD-EPI公式较MDRD公式可显示出较好的精确度及预测能力。3种公式估测的GFR与rGFR在总体及rGFR<60 ml.min-1.(1.73 m2)-1时显示明显的相关性。当分别以90或60 ml.min-1.(1.73 m2)-1作为诊断分界点时,受试者工作特征曲线(ROC)曲线下面积比较差异无统计学意义。结论 CKD-EPI公式较MDRD公式有较好的预测能力,但能否更准确地评估我国CKD患者的GFR及取代MDRD公式,尚需进一步研究。     

校正后简化MDRD方程评估慢性肾脏病患者肾小球滤过率的适用性评价

目的:评价校正后简化MDRD方程预测慢性肾脏病（CKD）患者肾小球滤过率（GFR）的适用性。方法:选择2005年1月至2007年1月在我院肾内科就诊的CKD患者481例,所有患者同步检验99mTc-GFR(reference GFR,rGFR)、血浆肌酐（Pcr）,并用简化MDRD方程（aGFR=186×\[Pcr\]-1.154×\[年龄(岁)\]-0.203×\[女性×0.742\]）、校正后简化MDRD方程（c-aGFR=175×\[Pcr\]-1.234×\[年龄(岁)\]-0.179×\[女性×0.79\]）计算预测的GFR,二者进行预测偏离度、精确度、准确性比较。结果:（1）总体比较：简化MDRD方程、校正后简化MDRD方程预测的估测GFR(estimated GFR,eGFR)与rGFR均呈显著相关(P<0.01)。与简化MDRD方程比较,校正后简化MDRD方程预测的eGFR表现了较低的偏差和绝对偏差(P<0.01);除预测的精确度略有增加,校正后简化MDRD较简化MDRD方程15%、30%和50%的准确性、预测的偏离度均有改善(P<0.05)。（2）CKD各期比较：与简化MDRD方程比较,校正后简化MDRD方程减小了除CKD 5期外其余各期的偏差(P<0.05),减小了CKD 1期的绝对偏差(P<0.05);提高了CKD 2期30%的准确性(P<0.01)。结论:校正后简化MDRD方程与简化MDRD方程比较,无论从总体或是CKD各期来讲,均显示出不同程度的优势。在目前暂无更好GFR评估方程的背景下,可用于我国CKD患者GFR的评估。     

肌酐-胱抑素C公式在糖尿病肾病超滤过检出中的作用

目的 比较MDRD公式、胱抑素C公式及肌酐-胱抑素C公式在中国糖尿病患者中的表现,尤其是在高滤过检出中的作用。 方法 选取笔者医院2155名糖尿病患者,以^99mTc-DTPA GFR为金标准,比较MDRD公式、胱抑素C公式及肌酐-胱抑素C公式在估测GFR方面的优劣。观测指标包括偏倚、精确性及准确性,并对各公式检测结果与金标准进行相关性及线性分析。采用ROC曲线评估各公式对肾功能不全及高滤过的诊断效能。 结果 MDRD、胱抑素C及肌酐-胱抑素C公式在总体人群中的绝对偏倚分别为18.98、28.74、18.04,肌酐-胱抑素C公式的偏倚显著低于其他公式(P<0.05),精确度最好(P<0.01)。与MDRD及胱抑素C公式相比,肌酐-胱抑素C公式的15%及50%准确性更高(P<0.05),ROC曲线显示,肌酐-胱抑素C公式能够更加准确的筛选超滤过患者(AUC=0.862, P<0.05)。 结论 肌酐-胱抑素C公式在中国糖尿病人群中的适用性优于MDRD及胱抑素C公式,肌酐-胱抑素C公式可用于筛选超滤过的糖尿病早期肾损伤的患者。     

慢性肾脏病患者血清Cystatin C与肾功能的相关研究

目的研究慢性肾脏病（CKD）患者各期血清胱抑素C（cystatin C）与血清肌酐（Scr）反应肾小球滤过率的敏感性,以及在CKD分期条件下cystatin C与GFR、Scr的关系。探讨胱抑素C在肾功能改变早期诊断中的临床价值。方法收集90例慢性肾脏病患者,对疾病严重程度采用校正后简化MDRD方程GFR=175×[PCr]-1.234×[年龄（岁）]-0.179×[女性×0.793]计算每个患者GFR值进行分期,并选取90例健康者作为对照组,采用乳胶颗粒增强免疫透射比浊分析法（PETIA）测定每例患者的血清胱抑素C浓度,同时抽取静脉血测定血清肌酐和尿素氮。将患者按不同GFR标准分组,比较组间及组内差异,分析各指标间可能存在的关系。结果 CKD2-5期患者血清cystatin C水平与对照组比较差异有统计学意义（P〈0.05）,且各组间比较差异有统计学意义。CKD各期中,cystatin C与GFR及各种生化指标行直线相关分析,cystatin C与GFR相关系数最大,相关性最密切。cystatin C与Scr诊断肾小球滤过功能下降敏感性比较,cystatin C敏感性较高。结论 Cystatin C反应肾功能早期损伤较Scr更敏感,其可以做为诊断早期肾功能改变的简便的测定方法,对早期慢性肾脏病患者的诊断具有重要临床意义。     

MDRD与CKD-EPI方程在我国早期慢性肾脏病患者中应用的比较

目的:评价CKD-EPI方程在中国早期肾脏病患者人群中的适用性。方法:选择528例南京地区慢性肾脏病(CKD)患者,以CKD-EPI方程与改良简化MDRD方程计算的肾小球滤过率(GFR)进行CKD分期,比较CKD-EPI方程与改良简化MDRD方程之间CKD各分期人数的百分比以及GFR(cGFR和mGFR)水平。结果:CKD-EPI方程与改良简化MDRD方程相关性良好(r=0.755,P<0.001);根据CKD-EPI方程和改良简化MDRD方程对患者CKD分期,两者间CKD 1期、CKD 2期人数的百分比差异有统计学意义(P<0.05),CKD 3期人数的百分比差异无统计学意义(P>0.05);但CKD-EPI方程计算得出的平均cGFR值低于改良简化MDRD方程计算得出的平均mGFR值,两者差异有统计学意义(P<0.05)。结论:当GFR>60 ml.min-1.1.73-2时,与改良简化MDRD方程比较,CKD-EPI方程存在低估GFR的倾向,其是否能否取代简化MDRD方程尚需进一步研究。     

胱抑素C和估算的肾小球滤过率在糖尿病肾病早期诊断中的应用

目的:探讨肾小球滤过率评估方程和胱抑素C(CysC)在糖尿病肾病中的应用。方法:测定2型糖尿病患者86例和20例健康体检者尿微量蛋白(MP)、尿微量白蛋白(M-Alb)、尿肌酐,血清肌酐(Scr)、血清胱抑素C;应用简化MDRD方程和Cockcroft-Gault方程(C-G)估算糖尿病患者的肾小球滤过率并与内生肌酐清除率比较。结果:糖尿病各组简化MDRD方程和Cockcroft-Gault方程估算的肾小球滤过率随内生肌酐清除率(Ccr)的降低而降低,Scr、CysC、MP、M-Alb随内生肌酐清除率(Ccr)的降低而升高;在60≤Ccr<90ml/[min·(1.73m2)],Scr、CysC、MP、M-Alb、MDRD-GFR、C-G-GFR的灵敏度分别为7.41%、14.8%、61.5%、55.6%、37.0%、40.7%。结论:CysC在GFR轻度异常时其灵敏度不如尿微量白蛋白、尿微量蛋白、用C-G方程、MDRD方程估算的肾小球滤过率。     

Performance of the CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equations in a multiethnic Asian population

INTRODUCTION

Clinical practice guidelines recommend using creatinine-based equations to estimate glomerular filtration rates (GFRs). While these equations were formulated for Caucasian-American populations and have adjustment coefficients for African-American populations, they are not validated for other ethnicities. The Chronic Kidney Disease-Epidemiology Collaborative Group (CKD-EPI) recently developed a new equation that uses both creatinine and cystatin C. We aimed to assess the accuracy of this equation in estimating the GFRs of participants (healthy and with chronic kidney disease [CKD]) from a multiethnic Asian population.

METHODS

Serum samples from the Asian Kidney Disease Study and the Singapore Kidney Function Study were used. GFR was measured using plasma clearance of ^99mTc-DTPA. GFR was estimated using the CKD-EPI equations. The performance of GFR estimation equations were examined using median and interquartile range values, and the percentage difference from the measured GFR.

RESULTS

The study comprised 335 participants (69.3% with CKD; 38.5% Chinese, 29.6% Malays, 23.6% Indians, 8.3% others), with a mean age of 53.5 ± 15.1 years. Mean standardised serum creatinine was 127 ± 86 µmol/L, while mean standardised serum cystatin C and mean measured GFR were 1.43 ± 0.74 mg/L and 67 ± 33 mL/min/1.73 m², respectively. The creatinine-cystatin C CKD-EPI equation performed the best, with an estimated GFR of 67 ± 35 mL/min/1.73 m².

CONCLUSION

The new creatinine-cystatin C equation estimated GFR with little bias, and had increased precision and accuracy in our multiethnic Asian population. This two-biomarker equation may increase the accuracy of population studies on CKD, without the need to consider ethnicity.     

Diagnostic accuracy of various glomerular filtration rates estimating equations in patients with chronic kidney disease and diabetes

Background The equations for estimating glomerular filtration rate （GFR） based on creatinine have been found to have limitations and have not been generalizable across all populations. Equations based on cystatin C provide an alternative method to estimate GFR. Whether the equation based on cystatin C alone or combined creatinine would improve GFR estimates has not been validated among Chinese patients with chronic kidney disease （CKD） and diabetes. The aim of this study was to compare the performance of the modification of diet in renal disease （MDRD） equation based on creatinine with the five cystatin C-based formulae for estimation of GFR in patients with CKD and diabetes. Methods A total of 166 patients with CKD and 91 patients with type 2 diabetes were enrolled in this study. Cystatin C was measured by using the particle-enhanced immunonephelometric method and estimated formulae proposed by five different investigator teams （Stevens, Ma, Rule, Macisaac and Perkins）. The plasma clearance of ^99mTc-DTPA was determined as measured GFR （mGFR）.Results For CKD patients, the bias and accuracy for the Ma and Macisaac equations were superior compared with the MDRD, and the mean results for the Ma formula were closer to mGFR than the other equations in CKD stages 2-5. The differences between Macisaac and mGFR in CKD stages 2-4 were significantly less than those in CKD stage 1 or 5.Stevens and Rule＇s formulae revealed a similar bias and accuracy compared with the MDRD equation. The MDRD formula had a higher accuracy in CKD stages 3-5 as compared with the results in other stages. For diabetic patients, the mean results between Macisaac and mGFR were closer than those of other equations in mGFR≥90 ml·min^-1·1.73 m^-2 stage, in GFR 60-89 ml·min^-1·1.73 m^-2 stage, the MDRD formula showed the smallest difference compared with other equations. All equations overestimated GFR in the cases with GFR 〈60 ml·min^-1·1.73 m^-2 stages. The MDRD formula had a greater accuracy within 50% of mGFR than the equations based on cystatin C in diabetic patients. Perkins formula showed a large positive bias and low accuracy, therefore it may not be suitable for assessing GFR in patients with CKD and diabetes. Conclusions The formulae for estimating GFR based on cystatin C or creatinine have different trends and accuracies in patients with CKD and diabetes, especially in patients with various GFR levels. The equations based on cystatin C provide less accurate results than MDRD formulae, at least in the diabetic patients. Therefore, whether the formulae based on cystatin C are superior to MDRD formula requires further investigation in large diverse populations.     

Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease

Background  The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed to address the systematic underestimation of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with relatively well-preserved kidney function. Performance of the new equation in the Chinese population is unknown. The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease (CKD).

Methods  We enrolled 450 Chinese patients (239 women and 211 men) with CKD in the present study. The renal dynamic imaging method was used to measure the referenced standard GFR (rGFR) for comparison with estimations using the two equations. Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics (ROC) analysis. Performance of the two equations in lower and higher estimated GFR (eGFR) subgroups was further investigated.

Results  Both eGFRs correlated well with rGFR (r=0.88, 0.81, P <0.05). In overall performance, the CKD-EPI equation showed less bias, higher precision and improved accuracy, and was better for detecting CKD. In the higher-eGFR subgroup, the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.

Conclusions  The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied. For the present, the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

     

胱抑素C评价早中期慢性肾脏病患者肾功能损害的临床价值

目的探讨血清胱抑素C(CysC)评价早中期慢性肾脏病(CKD)患者肾功能损害的临床价值。方法以2008年1月至2010年12月深圳市第六人民医院肾内科住院治疗的221例CKD1～3期患者为观察对象,测定CysC、血肌酐(SCr)、血尿素氮(BUN)、血尿酸(BUA)及血白蛋白(Alb),与MDRD公式计算的肾小球滤过率(GFR)进行比较。结果 CKD1～3期患者CysC随着GFR的下降而升高,各组间比较差异有统计学意义(P<0.05);血清CysC水平与SCr、BUN及BUA水平呈明显正相关(r=0.650,P=0.000;r=0.631,P=0.000;r=0.309,P=0.000),与GFR水平呈明显负相关(r=-0.717,P=0.000)。CKD2期患者CysC异常检出率为32.8%,SCr为0;CKD3期患者CysC异常检出率为73.0%,SCr为58.4%,CKD3期患者CysC、SCr的异常检出率差异有统计学意义(P<0.05)。CysC评估GFR的接受者操作特征曲线下面积(AUCROC)为0.853,敏感性为0.780,特异性为0.817;SCr的AUCROC为0.924,敏感性为0.793,特异性为0.958;联合CysC和SCr后,AUCROC上升至0.940,敏感性为0.853,特异性为0.950。结论 CysC是评估早中期CKD患者肾功能损害的敏感指标,联合应用CysC和SCr可提高对早中期慢性肾功能不全患者的诊断效能。     

Impact of creatinine production on the agreement between glomerular filtration rate estimates using cystatin C-derived,and 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations

Abstract

Background. It has recently been reported that patient selection has a strong impact on the agreement between glomerular filtration rate (GFR) estimates from serum cystatin C and creatinine. The aim of our study was to evaluate the effect of creatinine production rate (CPR) on this subject. Material and methods. GFR was estimated from serum cystatin C and from creatinine using the 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 50 healthy subjects, 43 patients with renal failure, 794 kidney and 104 liver transplant recipients, 61 patients with heart failure, 59 patients with biliary obstruction, and 113 critically ill patients.

Results. In the 295 patients with impaired CPR (< 900 mg/24 h/1.73 m²), discordances of more than 40% between GFR_MDRD4 and GFR_cystatinC were observed in 38% of cases, between GFR_MDRD6 and GFR_cystatinC in 22%, and between GFR_CKD-EPI and GFR_cystatinC in 27% (in all cases due to GFR overestimation from creatinine). In the 929 patients with maintained CPR (> 900 mg/24 h/1.73 m²), greater discordances than 40% between GFR_MDRD4 and GFR_cystatinC were observed in 8% of cases, between GFR_MDRD6 and GFR_cystatinC in 9%, and between GFR_CKD-EPI and GFR_cystatinC in 7% (in the major part of cases due to GFR overestimation from cystatin C). Conclusion. The main source of differences of more than 40% between GFR estimates from serum creatinine and cystatin C is a GFR overestimation in patients with low CPR and GFR underestimation in patients with high CPR by the creatinine-derived equations.     

基于血清肌酐的肾小球滤过率估算值与99mTc-肾小球滤过率的相关性9

目的 分析肾小球滤过率（GFR）公式估算值(eGFR)与99锝－二乙烯三胺五醋酸 (99mTc-DTPA)法测定值（99mTcGFR）的相关性,探讨适合中国慢性肾脏病（CKD）住院患者eGFR的估算方法。方法 选择1 033例慢性肾脏病住院患者作为研究对象,99mTc-DTPA肾动态显像法测定 99mTc-GFR,酶法检测血清肌酐（SCr）水平。采用Cockcroft-Gault公式、肾脏病膳食改良试验（MDRD）公式、简化MDRD公式、中国MDRD公式、中国简化MDRD公式及CKD-EPI公式计算并用体表面积（BSA）校正后得到eGFR,分别以C-G GFR、7GFR、aGFR、c-7GFR4、c-aGFR4和CKD-EPI-GFR表示。分析99mTc-GFR与eGFR的相关性。结果 相关回归分析显示,C-G GFR、7GFR、aGFR、c-7GFR4、c-aGFR4和CKD-EPI-GFR与99mTc-GFR的相关系数（r）分别为0.805、0.797、0.783、0.791、0.777和0.800,与99mTc-GFR偏差值均值分别为－2.46、－14.24、－16.53、－20.92、－22.92和－13.56。患者99mTc-GFR与SCr水平呈近似双曲线的关系。结论 在基于SCr的公式估算得到的eGFR中,C-G GFR与99mTc-GFR的相关程度最高。提示当以酶法SCr测定结果作为数据源时,C-G公式较适合中国CKD住院患者eGFR的估算。     

慢性肾脏病患者血清Cystatin C与肾功能的相关研究

目的:研究慢性肾脏病(CKD)患者各期血清胱抑素C(cystatin C)与血清肌酐(Scr)反应肾小球滤过率的敏感性,以及在CKD分期条件下cystatin C与GFR、Scr的关系。探讨胱抑素C在肾功能改变早期诊断中的临床价值。方法:收集90例慢性肾脏病患者,患者疾病严重程度采用校正后简化MDRD方程GFR=175×[PCr]-1.234×[年龄(岁)]-0.179×[女性×0.793]计算的每个患者GFR值进行分期,并选取90例健康者作为对照组,采用乳胶颗粒增强免疫透射比浊分析法(PETIA)测定每例患者的血清胱抑素C浓度,同时抽取静脉血测定血清肌酐和尿素氮。将患者按不同GFR标准分组,比较组间及组内差异,分析各指标间可能存在的关系。结果:CKD2-5期患者血清cystatin C水平与对照组比较差异有统计学意义(P<0.05),且各组间比较差异有统计学意义。CKD各期中,cystatin C与GFR及各种生化指标行直线相关分析,cystatin C与GFR相关系数最大,相关性最密切。cystatin C与Scr诊断肾小球滤过功能下降敏感性比较,cystatin C敏感性较高。结论:Cystatin C反应肾功能早期损伤较Scr更敏感,其可以做为诊断早期肾功能改变的简便的测定方法,对早期慢性肾脏病患者的诊断具有重要临床意义。